2型糖尿病患者抑郁现状及影响因素的研究进展

摘要目的：综述2型糖尿病患者抑郁现状及影响因素的研究进展。方法：检索中国知网、万方数据库、维普数据库以及PubMed等数据库中，2型糖尿病患者抑郁现状及影响因素的相关文献。使用“2型糖尿病”或“抑郁”或“影响因素”主题词于中国知网、万方数据库及维普数据库进行检索；使用“type2diabetesmellitus”and“depression”and“diet”and“influencefactor”or“riskfactors”主题词于PubMed数据库进行检索。结果：最终纳入58篇文献。结果显示：2型糖尿病患者抑郁水平比非糖尿病者增加1倍；常用的测量工具有抑郁自评量表（SDS）、汉密尔顿抑郁量表（HAMD）、患者健康问卷抑郁量表（PHQ-9）、医院焦虑抑郁量表（HADS）；文化程度、年龄、性别、并发症、糖化血红蛋白、病程、睡眠和生活质量是2型糖尿病患者抑郁的影响因素。其中，在社会人口学因素上，女性、老年人以及受教育程度较低者，抑郁发生率相对较高；在临床因素方面，病程长、糖化血红蛋白（HbA1c）水平高、伴有多种并发症的患者出现抑郁的风险显著增加。此外，睡眠质量差和生存质量差可也会加重患者抑郁症状。结论：发现问题后尽早采取多种干预手段较为重要，包括给患者详细讲解疾病知识开展系统化健康教育，帮助他们学会自己管理病情，同时给予心理疏导和社会支持有效缓解患者抑郁症状。这一系列的做法能减轻患者的抑郁情绪，让他们更积极地配合治疗并且能有助于改善疾病预后，提高患者的生活质量。关键词：2型糖尿病；抑郁；影响因素；评估工具；综述

ABSTRACTObjectives:ResearchProgressontheCurrentSituationandInfluencingFactorsofDepressioninPatientswithType2DiabetesMellitus.Methods:Searchforrelevantliteraturesonthecurrentdepressionstatusandinfluencingfactorsofpatientswithtype2diabetesindatabasessuchasCNKI,WanfangDatabase,VIPDatabase,andPubMed.Searchusingthesubjectterms“2型糖尿病”and“抑郁”and“影响因素”inCNKI,WanfangDatabase,VIPDatabaseandPubMed.Results:Atotalof58literatureswerefinallyincluded.Theresultsshowedthatthelevelofdepressioninpatientswithtype2diabeteswastwiceashighasthatinnon-diabeticindividuals.CommonlyusedmeasurementtoolsincludetheSelf-ratingDepressionScale(SDS),HamiltonDepressionScale(HAMD),PatientHealthQuestionnaireDepressionScale(PHQ-9),andHospitalAnxietyandDepressionScale(HADS).Educationalattainment,age,gender,complications,glycosylatedhemoglobin,diseaseduration,sleep,andqualityoflifeareinfluencingfactorsfordepressioninpatientswithtype2diabetes.Amongthem,intermsofsociodemographicfactors,women,theelderly,andthosewithlowereducationalattainmenthavearelativelyhigherincidenceofdepression.Intermsofclinicalfactors,patientswithalongdiseaseduration,highlevelsofglycosylatedhemoglobin(HbA1c),andmultiplecomplicationshaveasignificantlyincreasedriskofdepression.Inaddition,poorsleepqualityandpoorqualityoflifecanalsoexacerbatethedepressivesymptomsofpatients.Conclusion:EarlyandtimelyinterventioniscriticaltoalleviatedepressivesymptomsinpatientswithT2DM.Thiscanbeachievedthroughstrategiessuchasstrengtheninghealtheducation,enhancingself-managementcapacity,andprovidingpsychosocialsupport.Thesemeasuresempowerpatientstoovercomedepressiveemotions,adoptaproactiveapproachtodiseasemanagement,andtherebyimproveclinicalprognosisandqualityoflife.Keywords:Type2DiabetesMellitus,Depression,InfluencingFactors,AssessmentTools,Review

第一章绪论研究背景2型糖尿病（type2diabetesmellitus，T2DM）是指胰岛素分泌不足或效率降低导致，以慢性高血糖为特征的代谢性疾病，是临床上常见的一种慢性疾病。国际糖尿病联盟（IDF）统计表明ADDINZOTERO_ITEMCSL_CITATION{"citationID":"8M67Xp88","properties":{"formattedCitation":"\\super[1]\\nosupersub{}","plainCitation":"[1]","noteIndex":0},"citationItems":[{"id":302,"uris":["/users/16881652/items/TC8TLA7S"],"itemData":{"id":302,"type":"article-journal","abstract":"AIMS:Toprovideglobal,regional,andcountry-levelestimatesofdiabetesprevalenceandhealthexpendituresfor2021andprojectionsfor2045.\nMETHODS:Atotalof219datasourcesmeetingpre-establishedqualitycriteriareportingresearchconductedbetween2005and2020andrepresenting215countriesandterritorieswereidentified.Forcountrieswithoutdatameetingqualitycriteria,estimateswereextrapolatedfromcountrieswithsimilareconomies,ethnicity,geographyandlanguage.Logisticregressionwasusedtogeneratesmoothedage-specificdiabetesprevalenceestimates.Diabetes-relatedhealthexpenditureswereestimatedusinganattributablefractionmethod.The2021diabetesprevalenceestimateswereappliedtopopulationestimatesfor2045toprojectfutureprevalence.\nRESULTS:Theglobaldiabetesprevalencein20-79

yearoldsin2021wasestimatedtobe10.5%(536.6millionpeople),risingto12.2%(783.2million)in2045.Diabetesprevalencewassimilarinmenandwomenandwashighestinthoseaged75-79

years.Prevalence(in2021)wasestimatedtobehigherinurban(12.1%)thanrural(8.3%)areas,andinhigh-income(11.1%)comparedtolow-incomecountries(5.5%).Thegreatestrelativeincreaseintheprevalenceofdiabetesbetween2021and2045isexpectedtooccurinmiddle-incomecountries(21.1%)comparedtohigh-(12.2%)andlow-income(11.9%)countries.Globaldiabetes-relatedhealthexpenditureswereestimatedat966billionUSDin2021,andareprojectedtoreach1,054billionUSDby2045.\nCONCLUSIONS:Justoverhalfabillionpeoplearelivingwithdiabetesworldwidewhichmeansthatover10.5%oftheworld'sadultpopulationnowhavethiscondition.","call-number":"3","container-title":"DiabetesResearchandClinicalPractice","DOI":"10.1016/j.diabres.2021.109119","ISSN":"1872-8227","journalAbbreviation":"DiabetesRes.Clin.Pract.","language":"en","note":"PMID:34879977\nPMCID:PMC11057359","page":"109119","source":"6.1","title":"IDFdiabetesatlas:global,regionalandcountry-leveldiabetesprevalenceestimatesfor2021andprojectionsfor2045","title-short":"IDFdiabetesatlas","volume":"183","author":[{"family":"Sun","given":"Hong"},{"family":"Saeedi","given":"Pouya"},{"family":"Karuranga","given":"Suvi"},{"family":"Pinkepank","given":"Moritz"},{"family":"Ogurtsova","given":"Katherine"},{"family":"Duncan","given":"BruceB."},{"family":"Stein","given":"Caroline"},{"family":"Basit","given":"Abdul"},{"family":"Chan","given":"JulianaC.N."},{"family":"Mbanya","given":"JeanClaude"},{"family":"Pavkov","given":"MedaE."},{"family":"Ramachandaran","given":"Ambady"},{"family":"Wild","given":"SarahH."},{"family":"James","given":"Steven"},{"family":"Herman","given":"WilliamH."},{"family":"Zhang","given":"Ping"},{"family":"Bommer","given":"Christian"},{"family":"Kuo","given":"Shihchen"},{"family":"Boyko","given":"EdwardJ."},{"family":"Magliano","given":"DiannaJ."}],"issued":{"date-parts":[["2022",1]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[1]：2021年全球成年糖尿病患者数量约5.37亿，按预估2030年这一群体规模将扩大至6.43亿。更令人警惕的是，根据《柳叶刀》ADDINZOTERO_ITEMCSL_CITATION{"citationID":"70gVHvdv","properties":{"formattedCitation":"\\super[2]\\nosupersub{}","plainCitation":"[2]","noteIndex":0},"citationItems":[{"id":245,"uris":["/users/16881652/items/9E75BUK5"],"itemData":{"id":245,"type":"article-journal","abstract":"BACKGROUND:Diabetesisoneoftheleadingcausesofdeathanddisabilityworldwide,andaffectspeopleregardlessofcountry,agegroup,orsex.UsingthemostrecentevidentiaryandanalyticalframeworkfromtheGlobalBurdenofDiseases,Injuries,andRiskFactorsStudy(GBD),weproducedlocation-specific,age-specific,andsex-specificestimatesofdiabetesprevalenceandburdenfrom1990to2021,theproportionoftype1andtype2diabetesin2021,theproportionofthetype2diabetesburdenattributabletoselectedriskfactors,andprojectionsofdiabetesprevalencethrough2050.\nMETHODS:Estimatesofdiabetesprevalenceandburdenwerecomputedin204countriesandterritories,across25agegroups,formalesandfemalesseparatelyandcombined;theseestimatescomprisedlostyearsofhealthylife,measuredindisability-adjustedlife-years(DALYs;definedasthesumofyearsoflifelost[YLLs]andyearslivedwithdisability[YLDs]).WeusedtheCauseofDeathEnsemblemodel(CODEm)approachtoestimatedeathsduetodiabetes,incorporating25 666location-yearsofdatafromvitalregistrationandverbalautopsyreportsinseparatetotal(includingbothtype1andtype2diabetes)andtype-specificmodels.Otherformsofdiabetes,includinggestationalandmonogenicdiabetes,werenotexplicitlymodelled.Totalandtype1diabetesprevalencewasestimatedbyuseofaBayesianmeta-regressionmodellingtool,DisMod-MR2.1,toanalyse1527location-yearsofdatafromthescientificliterature,surveymicrodata,andinsuranceclaims;type2diabetesestimateswerecomputedbysubtractingtype1diabetesfromtotalestimates.Mortalityandprevalenceestimates,alongwithstandardlifeexpectancyanddisabilityweights,wereusedtocalculateYLLs,YLDs,andDALYs.Whenappropriate,weextrapolatedestimatestoahypotheticalpopulationwithastandardisedagestructuretoallowcomparisoninpopulationswithdifferentagestructures.Weusedthecomparativeriskassessmentframeworktoestimatetherisk-attributabletype2diabetesburdenfor16riskfactorsfallingunderriskcategoriesincludingenvironmentalandoccupationalfactors,tobaccouse,highalcoholuse,highbody-massindex(BMI),dietaryfactors,andlowphysicalactivity.Usingaregressionframework,weforecasttype1andtype2diabetesprevalencethrough2050withSocio-demographicIndex(SDI)andhighBMIaspredictors,respectively.\nFINDINGS:In2021,therewere529million(95%uncertaintyinterval[UI]500-564)peoplelivingwithdiabetesworldwide,andtheglobalage-standardisedtotaldiabetesprevalencewas6·1%(5·8-6·5).Atthesuper-regionlevel,thehighestage-standardisedrateswereobservedinnorthAfricaandtheMiddleEast(9·3%[8·7-9·9])and,attheregionallevel,inOceania(12·3%[11·5-13·0]).Nationally,Qatarhadtheworld'shighestage-specificprevalenceofdiabetes,at76·1%(73·1-79·5)inindividualsaged75-79years.Totaldiabetesprevalence-especiallyamongolderadults-primarilyreflectstype2diabetes,whichin2021accountedfor96·0%(95·1-96·8)ofdiabetescasesand95·4%(94·9-95·9)ofdiabetesDALYsworldwide.In2021,52·2%(25·5-71·8)ofglobaltype2diabetesDALYswereattributabletohighBMI.ThecontributionofhighBMItotype2diabetesDALYsroseby24·3%(18·5-30·4)worldwidebetween1990and2021.By2050,morethan1·31billion(1·22-1·39)peopleareprojectedtohavediabetes,withexpectedage-standardisedtotaldiabetesprevalenceratesgreaterthan10%intwosuper-regions:16·8%(16·1-17·6)innorthAfricaandtheMiddleEastand11·3%(10·8-11·9)inLatinAmericaandCaribbean.By2050,89(43·6%)of204countriesandterritorieswillhaveanage-standardisedrategreaterthan10%.\nINTERPRETATION:Diabetesremainsasubstantialpublichealthissue.Type2diabetes,whichmakesupthebulkofdiabetescases,islargelypreventableand,insomecases,potentiallyreversibleifidentifiedandmanagedearlyinthediseasecourse.However,allevidenceindicatesthatdiabetesprevalenceisincreasingworldwide,primarilyduetoariseinobesitycausedbymultiplefactors.Preventingandcontrollingtype2diabetesremainsanongoingchallenge.Itisessentialtobetterunderstanddisparitiesinriskfactorprofilesanddiabetesburdenacrosspopulations,toinformstrategiestosuccessfullycontroldiabetesriskfactorswithinthecontextofmultipleandcomplexdrivers.\nFUNDING:Bill&MelindaGatesFoundation.","container-title":"Lancet(london,England)","DOI":"10.1016/S0140-6736(23)01301-6","ISSN":"1474-547X","issue":"10397","journalAbbreviation":"Lancet(lond.Engl.)","language":"en","note":"PMID:37356446\nPMCID:PMC10364581","page":"203-234","source":"PubMed","title":"Global,regional,andnationalburdenofdiabetesfrom1990to2021,withprojectionsofprevalenceto2050:asystematicanalysisfortheglobalburdenofdiseasestudy2021","title-short":"Global,regional,andnationalburdenofdiabetesfrom1990to2021,withprojectionsofprevalenceto2050","volume":"402","author":[{"literal":"GBD2021DiabetesCollaborators"}],"issued":{"date-parts":[["2023",7,15]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[2]杂志最新发布的研究报告，预计至2050年，糖尿病患者的总数将翻一番，达到13亿之众。在这一庞大的患者群体中，T2DM占据了绝大多数，其全球范围内患病率估计为6%-9%之间，且绝大多数（约90%至95%）的糖尿病病例均为T2DM。近三十余年来，我国糖尿病的流行病学特征呈现为患病率的大幅增加。依据《中国2型糖尿病防治指南（2020年版）》指出ADDINZOTERO_ITEMCSL_CITATION{"citationID":"YawsuzQi","properties":{"formattedCitation":"\\super[3]\\nosupersub{}","plainCitation":"[3]","noteIndex":0},"citationItems":[{"id":251,"uris":["/users/16881652/items/BJZBW54P"],"itemData":{"id":251,"type":"article-journal","abstract":"糖尿病是内科常见病,与各学科疾病关联密切。对糖尿病的正确认识和防治是所有内科医生的必备知识。今特刊载中华医学会糖尿病学分会制定的最新指南——《中国2型糖尿病防治指南(2020年版)》,旨在及时传递糖尿病临床的重要进展,指导临床一线实践。指南共19章,内容涵盖中国糖尿病流行病学、糖尿病的诊断与分型、2型糖尿病的三级预防、糖尿病的筛查和评估、糖尿病的教育和管理、2型糖尿病综合控制目标和高血糖的治疗路径、医学营养、运动治疗和体重管理、高血糖的药物治疗、糖尿病相关技术、糖尿病急性和慢性并发症、低血糖、糖尿病的特殊情况、代谢综合征和糖尿病的中医药治疗等。受杂志刊载篇幅限制,将分两部分在2021年第8期和第9期刊登。","container-title":"中国实用内科杂志","DOI":"10.19538/j.nk2021080106","ISSN":"1005-2194","issue":"8","journalAbbreviation":"中国实用内科杂志","language":"zh","note":"download:78647\nalbum:医药卫生科技\nCLC:R587.1\nCNKICite:1714\ndbcode:CJFQ\ndbname:CJFDLAST2021\nfilename:SYNK202108007","page":"668-695","source":"CNKI","title":"中国2型糖尿病防治指南（2020年版）（上）","volume":"41","author":[{"family":"Society","given":"ChineseDiabetes"}],"issued":{"date-parts":[["2021"]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[3]，我国18岁及以上人群中糖尿病患病率达11.2%。在所有糖尿病患者中，超过9成为2型糖尿病，这也是最常见的糖尿病类型之一。当前2型糖尿病导致的身体病变以及患者出现的心理问题日益受到关注，已成为健康领域的重要研究方向。研究表明，T2DM患者伴有抑郁症状的风险比非糖尿病者增加1倍ADDINZOTERO_ITEMCSL_CITATION{"citationID":"iraUOeGG","properties":{"formattedCitation":"\\super[4]\\nosupersub{}","plainCitation":"[4]","noteIndex":0},"citationItems":[{"id":146,"uris":["/users/16881652/items/ZFHG8NE4"],"itemData":{"id":146,"type":"article-journal","abstract":"目的探讨心理干预对社区2型糖尿病(T2DM)合并抑郁患者的糖代谢的影响。方法以包头市友谊办事处社区卫生服务中心410例T2DM患者为研究对象,按照Zung抑郁自评量表(SDS)进行评价分析,测定出176例2型糖尿病伴抑郁患者。将176例T2DM伴抑郁患者按照随机数字表法分为实验组与对照组各88例,对照组采用常规治疗,实验组在常规治疗的基础上联合心理干预治疗。心理干预治疗3个月后重新测定2组空腹血糖(FPG)、餐后2h血糖(PG2h)、糖化血红蛋白(HbA1c)及SDS评分。心理干预治疗停止2个月后,随访再次测定FPG、PG2h及HbA1c,并重新进行抑郁水平以及生活质量状况评估,采用SPSS17.0统计软件进行分析。结果经心理干预治疗3个月,实验组FPG、PG2h、HbA1c明显低于对照组,并且实验组抑郁指数明显低于对照组,差异有统计学意义(P<0.01);心理干预停止后2月,实验组糖代谢指标明显低于对照组,抑郁指数明显低于对照组,差异有统计学意义(P<0.01)。结论心理干预可以有效改善社区2型糖尿病合并抑郁的抑郁症状及糖代谢指标,但需要长期坚持。","call-number":"11-5710/R","container-title":"中华全科医学","DOI":"10.16766/ki.issn.1674-4152.2017.01.034","ISSN":"1674-4152","issue":"1","language":"zh","note":"CNKICite:22","page":"110-112","title":"心理干预对社区2型糖尿病伴抑郁症状患者糖代谢的影响","volume":"15","author":[{"family":"薛君","given":""},{"family":"石丹华","given":""},{"family":"敖梅","given":""},{"family":"李磊","given":""},{"family":"冯朝霞","given":""},{"family":"吕果梅","given":""},{"family":"曹晓晶","given":""}],"issued":{"date-parts":[["2017"]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[4]。世界卫生组织（WHO）的研究显示，诸如心绞痛、糖尿病、关节炎等慢性躯体疾病与抑郁症状并存的情况在临床中较为普遍。临床研究表明ADDINZOTERO_ITEMCSL_CITATION{"citationID":"D0hFTCOA","properties":{"formattedCitation":"\\super[5]\\nosupersub{}","plainCitation":"[5]","noteIndex":0},"citationItems":[{"id":273,"uris":["/users/16881652/items/QK8E3DFK"],"itemData":{"id":273,"type":"article-journal","abstract":"BackgroundDepressionanddiabetesaremajorhealthchallenges,withheavyeconomicsocialburden,andcomorbiddepressionindiabetescouldleadtoawiderangeofpoorhealthoutcomes.Althoughmanydescriptivestudieshavehighlightedtheprevalenceofcomorbiddepressionanditsassociatedfactors,thesituationinHunan,China,remainsunclear.Therefore,thisstudyaimedtoidentifytheprevalenceofcomorbiddepressionandassociatedfactorsamonghospitalizedtype2diabetesmellitus(T2DM)patientsinHunan,China.\nMethodsThiscross-sectionalstudyinvolved496patientswithT2DMwhowerereferredtotheendocrinologyinpatientdepartmentofXiangyaHospitalaffiliatedtoCentralSouthUniversity,Hunan.Participants’dataonsociodemographicstatus,lifestylefactors,T2DM-relatedcharacteristics,andsocialsupportwerecollected.DepressionwasevaluatedusingtheHospitalAnxietyandDepressionScale-depressionsubscale.AllstatisticalanalyseswereconductedusingtheRsoftwareversion4.2.1.\nResultsTheprevalenceofcomorbiddepressionamonghospitalizedT2DMpatientsinHunanwas27.22%(95%ConfidenceInterval[CI]:23.3–31.1%).Individualswithdepressiondifferedsignificantlyfromthosewithoutdepressioninage,educationallevel,percapitamonthlyhouseholdincome,currentworkstatus,currentsmokingstatus,currentdrinkingstatus,regularphysicalactivity,durationofdiabetes,hypertension,chronickidneydisease,stroke,fattyliver,diabeticnephropathy,diabeticretinopathy,insulinuse,HbA1c,andsocialsupport.Amultivariablelogisticregressionmodelshowedthatinsulinusers(adjustedOR=1.86,95%CI:1.02–3.42)hadahigherriskofdepression,whilethosewithregularphysicalactivity(adjustedOR=0.48,95%CI:0.30–0.77)orgreatersocialsupport(adjustedOR=0.20,95%CI:0.11–0.34)hadalowerriskofdepression.Theareaunderthecurveofthereceiveroperatorcharacteristicbasedonthismodelwas0.741withasensitivityof0.785andspecificityof0.615.\nConclusionsDepressionwasmoderatelyprevalentamonghospitalizedT2DMpatientsinHunan,China.Insulintreatmentstrategies,regularphysicalactivity,andsocialsupportweresignificantlyindependentlyassociatedwith","call-number":"2","container-title":"BMCPsychiatry","DOI":"10.1186/s12888-023-04657-4","ISSN":"1471-244X","issue":"1","journalAbbreviation":"BMCPsychiatry","language":"en","page":"158","source":"3.4","title":"Prevalenceofcomorbiddepressionandassociatedfactorsamonghospitalizedpatientswithtype2diabetesmellitusinhunan,china","volume":"23","author":[{"family":"Maimaitituerxun","given":"Rehanguli"},{"family":"Chen","given":"Wenhang"},{"family":"Xiang","given":"Jingsha"},{"family":"Kaminga","given":"AtipatsaC."},{"family":"Wu","given":"XinYin"},{"family":"Chen","given":"Letao"},{"family":"Yang","given":"Jianzhou"},{"family":"Liu","given":"Aizhong"},{"family":"Dai","given":"Wenjie"}],"issued":{"date-parts":[["2023",3,14]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[5]，糖尿病患者群体中焦虑、抑郁等消极情绪的发生风险显著升高，其情绪异常状态受社会环境及疾病相关因素的综合影响，并对血糖调控产生不利作用。抑郁症状在T2DM患者中的普遍存在，且T2DM抑郁的风险与年龄、糖尿病持续患病时间还有血糖控制成正比ADDINZOTERO_ITEMCSL_CITATION{"citationID":"OPtmNdHc","properties":{"formattedCitation":"\\super[6]\\nosupersub{}","plainCitation":"[6]","noteIndex":0},"citationItems":[{"id":272,"uris":["/users/16881652/items/E337MITZ"],"itemData":{"id":272,"type":"article-journal","abstract":"Background:Diabetesmellitus(DM)isachronicconditionassociatedwithmultiplecomplicationsandcomorbidities.Someofthesecomorbiditiesareanxietyanddepression,withanegativeimpactonthequalityoflife,non-adherencetotreatment,andpoorprognosis.ThemainaimofthisstudywastoevaluatedepressionandanxietyinagroupofpatientswithDMandtheirimpactonqualityoflifeandidentifyfactorsthatimprovetheprognosisandincreasethelifeexpectancyandqualityoflifeofpatientswithDM.Methods:Atotalof209patientswithtype2DM(T2DM)wereenrolledcross-sectionally.Patientswerescreenedforpsychiatricdisorders,cognitiveimpairment,andmetabolicparameters.Results:Includedpatientshadamedianageof66.0(58;70)years,amedianDMdurationof9(6;15)years,andasuboptimalglycemiccontrolreflectedbyamedianHbA1cof7.8(7;9.2)mg/dL.Patientspresentedanxietyatdifferentstagesin51.5%ofcases,andsimilarly,depressionin37.5%ofcases.Age,durationofDM,HbA1c,andpostprandialhyperglycemia(PPG)werepredictivefactorsforanxietyanddepressioninpatientswithT2DM.Anage>57years(sensitivity84.3,specificity33.7,AUROC0.621,p=0.002)andanHbA1c>8.5%(sensitivity45.8,specificity83.1,AUROC=0.635,p<0.0001)predictahigherrateofanxiety,respectively,ofdepressioninthesepatients.Conclusions:PatientswithT2DMhaveanincreasedrateofanxietyanddepressionduetopersistenthyperglycemiaandaging,whichisexpressedinalowerqualityoflife.","call-number":"3(预警)","container-title":"JournalofClinicalMedicine","DOI":"10.3390/jcm13103006","ISSN":"2077-0383","issue":"10","journalAbbreviation":"J.Clin.Med.","language":"en","license":"/licenses/by/4.0/","page":"3006","source":"3","title":"PredictiveFactorsofAnxietyandDepressioninPatientswithType2DiabetesMellitus","volume":"13","author":[{"family":"Albai","given":"Oana"},{"family":"Timar","given":"Bogdan"},{"family":"Braha","given":"Adina"},{"family":"Timar","given":"Romulus"}],"issued":{"date-parts":[["2024",5,20]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[6]。抑郁会通过下丘脑-垂体-肾上腺轴紊乱降低胰岛素敏感性、加剧血糖波动ADDINZOTERO_ITEMCSL_CITATION{"citationID":"AAmo2aQG","properties":{"formattedCitation":"\\super[7]\\nosupersub{}","plainCitation":"[7]","noteIndex":0},"citationItems":[{"id":128,"uris":["/users/16881652/items/6UH77UNG"],"itemData":{"id":128,"type":"article-journal","abstract":"目的：分析社区2型糖尿病患者焦虑、抑郁的影响因素。方法：选取2021年10月—2022年6月于北京市西城区白纸坊社区卫生服务中心就诊的2型糖尿病患者372例作为研究对象，均给予自制调查问卷、广泛性焦虑量表(GAD-7)和患者健康问卷(PHQ-9)开展问卷调查，分析社区2型糖尿病患者焦虑、抑郁的独立影响因素。结果：372例患者焦虑发生率为18.55%(69/372)，抑郁发生率为33.33%(124/372)。多元线性分析结果显示，病程是社区2型糖尿病患者焦虑的独立影响因素(P<0.05)；性别、婚姻状况、2型糖尿病并发症数量、合并症数量是社区2型糖尿病患者抑郁的独立影响因素(P<0.05)。结论：社区2型糖尿病患者存在焦虑、抑郁风险，尤其是婚姻状况一般、糖尿病病程长、并发症多、合并症多的患者，临床有必要给予针对性心理干预。","call-number":"22-1405/R","container-title":"中国社区医师","ISSN":"1007-614X","issue":"29","language":"zh","page":"141-143","title":"社区2型糖尿病患者焦虑、抑郁的影响因素分析","volume":"40","author":[{"family":"邓兰兰","given":""},{"family":"李春玲","given":""}],"issued":{"date-parts":[["2024"]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[7]，还会导致患者自我管理能力下降、医疗依从性降低，最终增加医疗支出与早亡风险，不仅影响患者的生活质量，还可能增加并发症的风险，加重疾病ADDINZOTERO_ITEMCSL_CITATION{"citationID":"A61Z7K4T","properties":{"formattedCitation":"\\super[8]\\nosupersub{}","plainCitation":"[8]","noteIndex":0},"citationItems":[{"id":126,"uris":["/users/16881652/items/CU5T82KF"],"itemData":{"id":126,"type":"article-journal","abstract":"目的调查社区2型糖尿病伴抑郁状态老年人生存质量并分析其影响因素。方法采用便利抽样法纳入成都市两个社区2型糖尿病老年人，筛选伴有抑郁状态者作为研究对象，使用一般情况调查表、糖尿病患者生存质量特异性量表、D型人格问卷进行调查，运用多重线性回归分析明确生存质量的影响因素。结果85名社区2型糖尿病伴抑郁状态老年人生存质量总分为（60.47±4.20）分，4个维度得分由高到低依次为心理/精神功能、生理功能、社会关系和治疗，文化程度、收入水平、D型人格是生存质量的影响因素。结论社区2型糖尿病伴抑郁状态老年人生存质量水平不佳，社区医务工作者应针对性进行干预，提升其生存质量。","call-number":"51-1705/R","container-title":"成都医学院学报","ISSN":"1674-2257","issue":"6","language":"zh","note":"CNKICite:9","page":"784-787","title":"社区2型糖尿病伴抑郁状态老年人生存质量的影响因素分析","volume":"17","author":[{"family":"李燕","given":""},{"family":"张先庚","given":""},{"family":"杜娟","given":""},{"family":"秦瑶","given":""}],"issued":{"date-parts":[["2022"]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[8]。除上述发现外，国外研究人员还关注了性别差异，发现女性糖尿病患者抑郁症状的比例更高ADDINZOTERO_ITEMCSL_CITATION{"citationID":"x4OLFnnp","properties":{"formattedCitation":"\\super[9]\\nosupersub{}","plainCitation":"[9]","noteIndex":0},"citationItems":[{"id":263,"uris":["/users/16881652/items/RV6IAH5I"],"itemData":{"id":263,"type":"article-journal","abstract":"BackgroundTheprevalenceofdepressionishigheramongmidlifewomen,andtheyhavelesscontrolovertheirdiabetesduringthemenopausaltransition.However,thereislimitedevidenceontheassociationbetweentype2diabetesmellitusanddepressionamongKoreanwomenintheirmidlife.Thisstudyaimedtoexaminetheassociationbetweentype2diabetesmellitusanddepressionandexplorethelevelsofawarenessandtreatmentofdepressionamongKoreanmidlifewomenwithT2DM.\nMethodsThisisacross-sectionalanalysisstudyconductedusingdatafromtheKoreaNationalHealthandNutritionExaminationSurveysof2014,2016,and2018.Koreanwomenaged40–64yearswhorandomlyparticipatedinthesurveyswereincluded,and4,063midlifewomenwereselectedasstudyparticipants.Thediabetesprogressionstatusoftheparticipantswasclassifiedintodiabetes,pre-diabetes,andnon-diabetes.Furthermore,thePatientHealthQuestionnaire-9wasusedforscreeningdepression.Participants’awarenessrate,treatmentrateamongincidentcasesofdepression,andtreatmentrateamongawarenesscasesofdepressionwerealsoanalyzed.Fordataanalysis,theRao–Scottχ2test,multiplelogisticregression,andlinearregressionwereconductedusingSAS9.4softwareprogram.\nResultsTheprevalenceofdepressionsignificantlydifferedbetweendiabetes,pre-diabetes,andnon-diabetesgroups.However,depressionawareness,treatment/incident,andtreatment/awarenessratesdidnotdifferstatisticallybetweenthediabetesprogressionstatusgroups.Comparedtothenon-diabetesgroup,diabetesgrouphadahigheroddsratioofdepressionafteradjustingforgeneralandhealth-relatedfactors.Thus,thediabetesgrouphadsignificantlyhigherPHQ-9scoresthanthenon-diabetesgroupafteradjustingforcovariates.\nConclusionsWomenintheirmidlifewhohavetype2diabetesmellitustendtohavehigherlevelsofdepressivesymptomsandareatriskofdepression.However,wefoundnosignificantdifferencesbetweendiabetesandnondiabetesregardingtheawarenessandtreatmentratesofdepressioninSouthKorea.Werecommendthatfuturestudiesfocusondevelopingclinicalpracticeguidelinesaimedatadditionalscreeningandinterventionfordepressioninmidlifewomenwithtype2diabetesmellitustoensureprompttreatmentandimprovedoutcomes.","call-number":"2","container-title":"BMCNursing","DOI":"10.1186/s12912-023-01385-8","ISSN":"1472-6955","issue":"1","journalAbbreviation":"BMCNurs.","language":"en","page":"237","source":"3.1","title":"Associationbetweentype2diabetesmellitusanddepressionamongkoreanmidlifewomen:across-sectionalanalysisstudy","title-short":"Associationbetweentype2diabetesmellitusanddepressionamongkoreanmidlifewomen","volume":"22","author":[{"family":"Yang","given":"YouLee"},{"family":"Im","given":"Eun-Ok"},{"family":"Kim","given":"Yunmi"}],"issued":{"date-parts":[["2023",7,10]]}}}],"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[9]。国内近年多项研究指出，2型糖尿病（T2DM）患者群体中患有抑郁症状的发生比例显著高于非糖尿病人群，有研究显示，20%-40%的糖尿病患者处于抑郁状态ADDINZOTERO_ITEMCSL_CITATION{"citationID":"Mrs8x49Z","properties":{"formattedCitation":"\\super[10]\\nosupersub{}","plainCitation":"[10]","noteIndex":0},"citationItems":[{"id":298,"uris":["/users/16881652/items/S9S52PMZ"],"itemData":{"id":298,"type":"article-journal","abstract":"IntheUnitedStates,9.3%ofthepopulation,or29.1millionpeoplehavediabetes,anddepressionaffects20%to40%oftheseindividuals.Diabeticfootulcersareacommonandseriouscomplicationofdiabetesandoneofthemostcostly.Itisestimatedthat2%to3%ofpersonswithdiabeteswilldevelopdiabeticfootulcerseachyear.Thereisanassociationbetweendepressionandthedevelopmentofdiabeticfootulcers.Theestimatedcostsassociatedwithmanagingdiabetes,depression,anddiabeticfootulcersplaceasub